Omicron presents unique challenges for Quebec hospitals

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Quebec hospitals are grappling with a new phenomenon in the latest wave of COVID-19: how to classify adult patients who test positive for the coronavirus but have mild or no symptoms and whose primary diagnosis for admission was a medical condition other than the pandemic. illness.

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In earlier waves, these patients were few and far between. But since the Omicron variant swept the province last month, up to 30 percent of patients are admitted not for COVID, but for something else – for example, appendicitis or a urinary tract infection – and they test positive only once. they are inthe hospital.

Additionally, hospitalizations in Quebec for COVID as a primary diagnosis are much shorter than in the past, suggesting that while Omicron may be much more contagious, it is not as severe – a trend that has been observed in South Africa, where it emerged. the variant.

But doctors are quick to warn that the data is preliminary, and that hospitalizations are rising rapidly in a depleted healthcare network that is more overloaded than ever. The fifth wave is also affecting the pediatric population differently, with hospitalizations among Quebec children up to the age of nine now at their highest level since the start of the pandemic.

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“What we are seeing with Omicron is that it is much more contagious than Delta (variant), but at the same time, people who are infected with Omicron, as a group, tend to be less ill than those who are caught with Delta,” He said. Dr. François Marquis, head of intensive care at Maisonneuve-Rosemont Hospital.

“Most of the patients in our ICU right now are Delta patients, while the majority of the patients that are admitted to the wards are basically all Omicrons. At this point, the vast majority of them do not require critical care. “

At the Jewish General, one in two patients admitted to the hospital does not have COVID as their primary diagnosis, Dr. Lawrence Rosenberg, executive director of the central-west health authority, told the Montreal Gazette.

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“They are not as sick as the people we admitted in the previous waves and they don’t stay in the hospital that long,” Rosenberg said. “Actually, we are not inundated with ICU patients. All of this bodes well and speaks to the effectiveness of the vaccination program. “

Still, Quebec on Tuesday reported the largest increase in single-day hospitalizations since the start of the pandemic: 196, bringing the total to 1,592. However, the ICU increases from four to 185. The capacity of the province’s ICU is 319 beds.

Hospitals are now considering stopping the practice of transferring each asymptomatic COVID patient with a different primary diagnosis to a COVID ward and instead keeping them in their original ward with additional precautions. The government is also considering publishing a new category of hospitalizations to distinguish patients who have COVID as their primary diagnosis from those who test positive as a secondary diagnosis.

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At first glance, the latest wave looks eerily similar to last January. On January 3 of last year, Quebec recorded a count of 1,294 hospitalizations, of which 188 were ICU stays. But that’s where the similarities end.

On the same date in 2021, the Ministry of Health declared 2,546 new cases of COVID. On Tuesday, the province recorded 14,494 cases, and that number is likely a huge understatement because many Quebecers self-assess and the government is not tabulating those results.

Additionally, the average number of COVID deaths in seven days stood at 31 on January 3 of last year, compared to an average of nearly 13 in the past seven days.

The difference in pediatric hospitals is also striking. On January 3 of last year, Quebec reported a new hospitalization in the demographic age zero to nine. On Tuesday, the province tallied 15 new hospitalizations in children as young as nine. To date, 56 percent of Quebec’s population ages five to 11 have received a dose of the COVID vaccine, a rate that is well below what is needed to counter Omicron.

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These pediatric statistics could help explain why Montreal’s public health department announced Monday that it was repealing a provincial daycare directive that children and educators who come into contact with someone known to be infected with COVID no longer have to isolate themselves. for 10 days. Quebec backed down on the directive on Tuesday.

Omicron also sets itself apart from previous waves in the number of breakthrough infections among those who have received two doses of the vaccine. Almost 78 percent of new cases Tuesday were in those who received two injections. In the last 28 days, 62% of those hospitalized were twice vaccinated.

Marquis and Rosenberg have observed some Quebecers who received the booster and yet tested positive for COVID. But they emphasized that vaccines are highly effective in reducing hospitalizations, avoiding ICU stays and preventing death.

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Rosenberg was cautiously optimistic that the Omicron wave could peak in the next two weeks, a prediction some American experts have made. But Marquis cautioned that Quebec’s health network could also be overwhelmed very quickly.

“It is the law of large numbers,” he explained. “Omicron is so incredibly contagious that it will probably spread across Canada from coast to coast. You just don’t want to get it at the same time as everyone else. “

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